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- Title
Sorafenib vs surgical resection for hepatocellular carcinoma with macrovascular invasion: A propensity score analysis.
- Authors
Costentin, Charlotte E.; Decaens, Thomas; Laurent, Alexis; Nault, Jean‐Charles; Paule, Bernard; Letoublon, Christian; Luciani, Alain; Calderaro, Julien; Adam, René; Bricault, Ivan; Amaddeo, Giuliana; Cherqui, Daniel; Mallat, Ariane; Samuel, Didier; Duvoux, Christophe; Ganne‐Carrié, Nathalie; Roudot‐Thoraval, Françoise; Vibert, Eric
- Abstract
Background & Aim Sorafenib is the standard of care for patients with hepatocellular carcinoma ( HCC) and macrovascular invasion ( MVI), with limited survival. Retrospective surgical studies have reported prolonged survival in this situation. This study aimed to compare the overall survival of patients with HCC and MVI treated with surgical resection or sorafenib. Methods A total of 143 patients with HCC and MVI but no extra-hepatic spread, treated with surgical resection ( SR-patients; n=75) or sorafenib ( SOR-patients; n=68) in four French centres between 1990 and 2013 were reviewed retrospectively. A propensity score analysis was performed to reduce bias. Results SR-patients were significantly younger and had a lower tumour burden than SOR-patients. Median overall survival ( OS) rates were 10.1 months [95% CI: 4.1-16.1] in SR-patients and 12.9 months [95% CI: 7.9-17.9] in SOR-patients ( P=.959). The 90-day mortality rate was 16% (n=12) in SR-patients and 7.5% (n=5) in SOR-patients ( P=.196). SR-patients had a median disease-free survival of 4.60 months [95% CI: 3.3-5.9]. Under the propensity analysis, median OS was 12.0 months [95% CI: 5.5-18.5] in SR-patients vs 9.7 months [95% CI: 6.1-13.3] in SOR-patients ( P=.682). Under multivariate analysis, extensive MVI ( HR=1.956, P=.024) and bilirubin >17 μmol/L ( HR=1.738, P=.011) were the two factors significantly associated with mortality. Conclusion Under a propensity score analysis, the overall survival of patients with HCC and MVI undergoing surgical resection was similar to that achieved with sorafenib. We were not able to identify a patient subgroup experiencing a surgery-related improvement in survival, and quality of life was not evaluable.
- Subjects
SORAFENIB; LIVER cancer; SURGICAL excision; TUMORS; SURGERY; PATIENTS
- Publication
Liver International, 2017, Vol 37, Issue 12, p1869
- ISSN
1478-3223
- Publication type
Article
- DOI
10.1111/liv.13491